NICK BOYLE: How the NHS wastes billions over everything from drugs to surgical gloves... by a top consultant surgeon

The financial challenges are severe, not least because of an elderly population (posed by model)

Despite record funding increases in recent years, the shadow of impending crisis continues to loom over the NHS. We are facing a ticking bankruptcy time bomb.

The financial challenges are severe, not least because of the rising demand that results from a growing and increasingly elderly population. Services are badly overstretched in some parts of the country, waiting lists are increasing and standards of care are inconsistent.

A third of NHS trusts are now in deficit, compared with just 10 per cent in 2010. As a whole, the NHS faces a £30 billion black hole by the end of the decade.

Inevitably, the consequences of these financial difficulties are often felt by patients. The number of people waiting for an operation for more than 18 weeks has hit three million, the highest level for six years.

And it isn’t just hospitals that are affected. A recent study by the Patients’ Association revealed that 60 per cent of the public are no longer able to see their GP within 48 hours.

Yet, as a consultant surgeon, I know it would be wrong to blame these worsening difficulties on the professionals who work in the NHS.

The organisation is filled with dedicated people, including doctors, nurses, managers and ancillary staff, who want to do their best for patients. Indeed, the very reason they joined the NHS was because of their compassion and commitment to service.

The problem, as I argued in this paper last week, is that they work in a top-down, monolithic system, whose bureaucratic culture is sluggish to respond to new demands.

It has an excessively hierarchical, sclerotic approach that tackles inefficiencies slowly. It is a world where duplication is rife, coordination rare, initiative discouraged and frustration widespread.

The health service can also — at its worst — be unthinkingly wasteful.

Take the issue of medical gloves. It has been estimated that the NHS could save £5 million overnight if the best-value gloves were used throughout the service.

In the past at Hinchingbrooke Hospital, Cambridge, which is run by Circle Partnership, of which I am a partner, several types of gloves were provided for surgeons. After a trial, we now use a single supplier and have cut costs by 25 per cent.

Other savings extend far beyond the operating theatre. For example, when a dishwasher broke down at Hinchingbrooke, the admin staff looked through the NHS procurement catalogues for a replacement.

The problem is they work in a top-down, monolithic system, whose bureaucratic culture is sluggish (file photo)

All they could find were machines costing several hundred pounds. So, sensibly, they went to the local branch of Currys and bought one for just £150 using the corporate credit card.

And during a warm spell, elderly patients on one ward were getting very hot. Instead of going through the usual long-winded NHS procedures, staff contacted a local firm, and portable air-conditioning was installed the next day. Incidentally, I was told that a nearby hospital, which relies on the NHS’s contractors, was still waiting for air conditioning several weeks later.

Huge savings have also been made on plans to revamp the intensive care unit. The original estimate was £7.5 million — but much of that involved unnecessary expenditure on the building works. The plans were revised, and the unit will be opened at a cost of just £2.5 million.

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There are bigger savings to be made, too. An analysis to be published next month has found that the NHS could save £2 billion by the end of the current spending review period by reassessing drugs procurement, reconsidering staff contracts and selling off land.

Indeed, the NHS owns vast swathes of land that it is not using to good effect. The junior health minister Daniel Poulter has identified the equivalent area of 1,300 football pitches that is owned by the NHS but is not being used. He has suggested it be sold off to build affordable homes.

Outspoken: Consultant surgeon Nick Boyle

Millions could be saved, too, if trusts bought non-branded drugs. And there is a potential £450 million to be made by reducing the number of temporary doctors and nurses — who cost five times as much as staff.

But while all of these add up to potentially large savings, what the health service really needs is a dramatic change in its culture.

And there is an increasing consensus that the answer to its top-heavy bureaucracy cannot be yet another major reorganisation driven by Westminster politicians.

We have already had far too many of those in recent years. They give the illusion of dynamic reform, while in reality often lead to greater costs and more unnecessary upheaval. The last major reorganisation alone is estimated to have cost £3 billion.

We must instead give power and responsibility for patient care to the clinical staff. This is a move popular with patients. An Ipsos Mori poll this week found 65 per cent of people would like the NHS to be run by doctors.

When we took over Hinchingbrooke, it was in dire financial straits and facing closure. There was scepticism from the local public and opposition from the trade unions at the move. Yet in just two years, Hinchingbrooke has won a respected national award for the best quality of care given to patients by any hospital in England.

Uniquely in the NHS, the majority of the executive board is made up of doctors. One consequence of this is that nurses now spend far more time dealing directly with patients instead of handling administration.

Putting doctors and nurses in charge has lead to other improvements. At another of our hospitals, in Bath, all the clinicians got together to rationalise the procedure for carrying out hip and knee replacements. Most NHS hospitals carry out, on average, four a day. But at Bath, they agreed to use the same knee and hip prostheses, reducing the costs by 50 per cent. They now perform an average of seven major operations a day.

The principle is the same in my own field. When carrying out gall-bladder operations with keyhole surgery, the surgeon is usually offered a range of disposable equipment, some of which can be expensive. But most surgeons know they could safely undertake this procedure without all of the more costly disposable instruments.

The result is a significant saving for the NHS in every gall-bladder operation performed.

Giving
more power to staff also improves co-ordination between services,
something that is a major problem within the traditional NHS, where
there is so often a breakdown in communication between GPs, clinics and
different parts of hospitals.

The NHS is a deeply conservative, sometimes insular organisation (picture posed by models)

Take one common example. Elderly people who break their hips need to treated very quickly to prevent the onset of complications after surgery.

At our hospital, the clinical team set up a new specialist position of ‘consultant ortho-geriatrician’ to co-ordinate this care. As a result, the average stay of patients following an emergency admission for a fractured hip has fallen from 21 to 14 days, thereby reducing costs, freeing up capacity and improving the quality of care.

And quality does not have to mean more money. Hinchingbrooke has achieved yearly savings of 7 per cent. That’s worth remembering when we talk about the ‘financial crisis’ facing the NHS — a crisis that demands the organisation makes 4 per cent annual savings.

There’s also much we could learn from other industries, such as car manufacturing, retail and technology.

One of our practices, called ‘Stop The Line’, means a staff member can call an immediate halt to an operation if they feel a problem has arisen. This was inspired by a similar procedure on the production line of the Japanese car-maker Toyota.

The NHS is a deeply conservative, sometimes insular organisation. Its most vociferous advocates seem to believe that more cash is the answer to every problem — rather than showing enthusiasm for new ways of working.

Our health service has a wonderful history, winning deep affection from the British public. But it cannot continue as it is.

If it does, the looming crisis will become an inevitability. And it is patients, I fear, who will suffer the most.